2022
DOI: 10.1001/jamaneurol.2021.4584
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Association Between Antiseizure Drug Monotherapy and Mortality for Patients With Poststroke Epilepsy

Abstract: The relationship between epilepsy and stroke is complicated. While stroke is a major cause of epilepsy after middle age, there is also evidence that the risk of stroke is increased in persons with epilepsy. The overall aim of this dissertation is to elaborate on the prognosis and treatment of epilepsy in older adults and its association to stroke. It is based on four studies which have been conducted using information from linked national registers, which offer unique opportunities to follow thousands of patie… Show more

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Cited by 28 publications
(13 citation statements)
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References 162 publications
(287 reference statements)
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“…by valproic acid‐induced thrombocytopenia or bleeding with concomitant use of phenytoin, valproic acid, or levetiracetam 55 In a nested case–control study involving 89 284 patients with atrial fibrillation and venous thromboembolism, the use of DOACs combined with phenytoin, carbamazepine, valproic acid, and levetiracetam was associated with 2.18 higher risk of stroke and systemic embolism 56 . Levetiracetam has however been associated with a lower risk of cardiovascular death associated with levetiracetam compared with carbamazepine treatment in patients with poststroke epilepsy in a population‐based setting 57 . To date, the clinical significance of DOAC interactions with mild‐to‐moderate CYP3A4/P‐gp‐inducing ASMs such as oxcarbazepine and cenobamate or enzyme‐inhibiting ASMs (e.g., cannabidiol, felbamate) is unknown.…”
Section: Main Bodymentioning
confidence: 99%
See 1 more Smart Citation
“…by valproic acid‐induced thrombocytopenia or bleeding with concomitant use of phenytoin, valproic acid, or levetiracetam 55 In a nested case–control study involving 89 284 patients with atrial fibrillation and venous thromboembolism, the use of DOACs combined with phenytoin, carbamazepine, valproic acid, and levetiracetam was associated with 2.18 higher risk of stroke and systemic embolism 56 . Levetiracetam has however been associated with a lower risk of cardiovascular death associated with levetiracetam compared with carbamazepine treatment in patients with poststroke epilepsy in a population‐based setting 57 . To date, the clinical significance of DOAC interactions with mild‐to‐moderate CYP3A4/P‐gp‐inducing ASMs such as oxcarbazepine and cenobamate or enzyme‐inhibiting ASMs (e.g., cannabidiol, felbamate) is unknown.…”
Section: Main Bodymentioning
confidence: 99%
“…56 Levetiracetam has however been associated with a lower risk of cardiovascular death associated with levetiracetam compared with carbamazepine treatment in patients with poststroke epilepsy in a population-based setting. 57 To date, the clinical significance of DOAC interactions with mild-to-moderate CYP3A4/P-gp-inducing ASMs such as oxcarbazepine and cenobamate or enzyme-inhibiting ASMs (e.g., cannabidiol, felbamate) is unknown. According to the relevant European Heart Rhythm Association Guide, 55 when an ASM therapy should be started in a patient treated with a DOAC (or vice versa), interdisciplinary review with the treating cardiologist, neurologist, primary care physician, and clinical pharmacist is crucial, and measurement of DOAC serum concentrations and close follow-up is advised.…”
Section: Drug Interactions Between Asmsmentioning
confidence: 99%
“…Epilepsy has been found to be closely related to stroke and dementia . In the present study’s population, a previous diagnosis of stroke or dementia was associated with the occurrence of epilepsy (HR, 1.93; 95% CI, 1.65-2.67; P < .001 for stroke and HR, 1.66; 95% CI, 1.35-1.96; P < .001 for dementia).…”
Section: Resultsmentioning
confidence: 52%
“…Also, indirect comparisons of LEV and LTG did not reveal differences in seizure freedom (odds ratio 0.86; 95% CI: 0.15.− 4.89) [10]. However, significantly lower mortality was seen with LTG monotherapy compared to therapy with CBZ [18] and overall, therapy with newer ASMs showed better seizure control and better tolerability compared with older ASMs [19].…”
Section: Discussionmentioning
confidence: 95%